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Knochel K, Zaimovic V, Gatzweiler B, Hein KK, Heitkamp N, Monz A, Reimann D, Borasio GD, Führer M. Participatory Development of a Modular Advance Care Planning Program in Pediatric Palliative Care (MAPPS). J Pain Symptom Manage 2022; 63:189-198. [PMID: 34597758 DOI: 10.1016/j.jpainsymman.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Decision-making in pediatric palliative care concerns mainly children without decision-making capacity. It has to balance the child's best interests, parental responsibility and the impact on the family system. OBJECTIVES Advance care planning (ACP) supports decision making about future medical care. A consistent pediatric approach is still missing. This study aimed at developing a pediatric ACP program (pedACP) meeting specific needs of children, parents and professionals. METHODS Bereaved parents of children with life-limiting conditions and professionals involved in pedACP participated. Employing the technique of constellation analysis, they collaboratively assigned content, actors, tools and warning notes about pedACP along a timeline. The researchers analyzed, systematized and translated these results into a pedACP program draft, which was revised by the participants. RESULTS The participants' overall focus was on the children's quality of life and an individualized interdisciplinary communication process along the disease trajectory. The program was conceptualized in modular design with fixed modules at the beginning (to build a trustful relationship and frame the process) and at the end (to summarize results and prepare implementation). The main discussions are structured in flexible modules (About the child, Emergencies, Disease-specific scenarios and End of life care). General themes cover timing, communication, engaging children and structural issues. The participants appreciated the program's comprehensiveness and flexibility. CONCLUSION Parents and professionals combined their perspectives on reflecting goals of care and the complexity of pedACP. They perceived the resulting modular program as suitable for meeting the individual needs of patients, families and professional stakeholders.
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Affiliation(s)
- Kathrin Knochel
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Vedrana Zaimovic
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Birga Gatzweiler
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Kerstin K Hein
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Nari Heitkamp
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Anna Monz
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Daniel Reimann
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service (G.D.B.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Monika Führer
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany.
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Geurtzen R, van den Heuvel JFM, Huisman JJ, Lutke Holzik EM, Bekker MN, Hogeveen M. Decision-making in imminent extreme premature births: perceived shared decision-making, parental decisional conflict and decision regret. J Perinatol 2021; 41:2201-2207. [PMID: 34285357 DOI: 10.1038/s41372-021-01159-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe levels of perceived shared decision making (SDM), decisional conflict (DC), and decision regret (DR) in prenatal counseling by pregnant women, partners, neonatologists, and obstetricians regarding decision-making around imminent extreme premature birth in which a decision about palliative comfort care versus early intensive care had to be made. STUDY DESIGN Multicenter, cross-sectional study using surveys to determine perceived SDM at imminent extreme premature birth in parents and physicians, and to determine DC and DR in parents. RESULTS In total, 73 participants from 22 prenatal counseling sessions were included (21 pregnant women, 20 partners, 14 obstetricians, 18 neonatologists). High perceived levels of SDM were found (median 82,2), and low levels of DC (median 23,4) and DR at one month (median 12, 5). CONCLUSIONS Reported levels of self-perceived SDM in the setting of prenatal counseling in extreme prematurity were high, by both the parents and the physicians. Levels of DC and DR were low.
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Affiliation(s)
- R Geurtzen
- Amalia Children's Hospital, department of neonatology, Radboud university medical center, Nijmegen, The Netherlands.
| | - J F M van den Heuvel
- Department of Obstetrics and Gynecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - J J Huisman
- Department of Obstetrics and Gynecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - E M Lutke Holzik
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - M N Bekker
- Department of Obstetrics and Gynecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - M Hogeveen
- Amalia Children's Hospital, department of neonatology, Radboud university medical center, Nijmegen, The Netherlands
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